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<p>We describe a case of refractory chylous ascites (RCA) successfully managed with a Denver shunt (DS) after conversion surgery for unresectable locally advanced pancreatic cancer. A 55-year-old woman developed RCA 6 months after distal pancreatectomy with celiac axis and portal vein resection. Conservative therapy, lymphangiography, and repeated paracentesis were ineffective. After confirming negative cytology, culture, and endotoxin tests, DS placement on postoperative day 425 resulted in rapid resolution of ascites, accompanied by improvement in body weight and hypoalbuminemia. No early major complications were observed after DS placement, and she was discharged safely. Although the shunt was removed 29 months later because of internal jugular vein thrombosis, no reaccumulation of ascites was observed thereafter. The patient remains alive without reaccumulation of ascites or tumor recurrence 60 months after curative resection. Although careful patient selection is essential because of potential complications, DS may serve as an effective salvage option for postoperative RCA when conservative approaches fail.</p>

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Successful management of refractory chylous ascites using a Denver shunt following conversion surgery for unresectable locally advanced pancreatic cancer

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月16日

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  • Dongha Lee,
  • Keiko Kamei,
  • Masaya Nakano,
  • Katsuya Ami,
  • Chihoko Nobori,
  • Yuta Yoshida,
  • Takaaki Murase,
  • Kentaro Tai,
  • Atsushi Takebe,
  • Ippei Matsumoto

摘要

We describe a case of refractory chylous ascites (RCA) successfully managed with a Denver shunt (DS) after conversion surgery for unresectable locally advanced pancreatic cancer. A 55-year-old woman developed RCA 6 months after distal pancreatectomy with celiac axis and portal vein resection. Conservative therapy, lymphangiography, and repeated paracentesis were ineffective. After confirming negative cytology, culture, and endotoxin tests, DS placement on postoperative day 425 resulted in rapid resolution of ascites, accompanied by improvement in body weight and hypoalbuminemia. No early major complications were observed after DS placement, and she was discharged safely. Although the shunt was removed 29 months later because of internal jugular vein thrombosis, no reaccumulation of ascites was observed thereafter. The patient remains alive without reaccumulation of ascites or tumor recurrence 60 months after curative resection. Although careful patient selection is essential because of potential complications, DS may serve as an effective salvage option for postoperative RCA when conservative approaches fail.